European Society of Gastrointestinal Endoscopy, ESGE

ESGE HEADLINE NEWS N°6, Sep 2006, The challenge of high-resolution endoscopy

ESGE HEADLINE NEWS N°6

The challenge of high-resolution endoscopy

R. Lambert, Screening Group, IARC, Lyon, France

Synopsis

The dramatic improvement in the images obtained by the newer electronic video endoscopes has resulted from a number of factors, including the high density of pixels in the charge-coupled device, new processors and high-definition monitors, image processing with structure enhancement, color enhancement, narrow-band imaging, and magnification with optical or electronic zoom.

High-resolution endoscopy is a development in diagnostic endoscopy that opens up a new era in the endoscopic diagnosis of early cancer: the focus is now on flat precancerous and cancerous neoplastic lesions, which the technique has made more visible and conspicuous. On the other hand, the spectrum of clinically irrelevant abnormalities of the mucosal surface that can now be detected is also considerably increased, with an attendant increased risk of overtreatment.

While the diagnosis of polypoid lesions is easy, the endoscopic diagnosis of nonpolypoid lesions requires a step-by-step strategy. The first step is the detection of an abnormal area, such as a discolored area or a sharp demarcation line. The next step is characterization of the lesion, based on the microvascular pattern, the gross morphology, and the degree of magnification available. The final step is a treatment decision based on the provisional diagnosis: no resection of lesions considered to be without clinical relevance, resection or surveillance for low-grade dysplasia, resection for high-grade noninvasive dysplasia, and resection or direct surgical treatment for early cancer, according to the estimation of the depth of invasion in the submucosa.

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